Hypertension cme -dr.saranya
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Transcript of Hypertension cme -dr.saranya
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HYPERTENSION
Dr.SARANYA VINOTH
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INTRODUCTION• Hypertension (high blood preassure) also called silent killer is a chronic medical condition characterized by constant elevation of the systolic or diastolic pressure above 140/90 mmHg.
• Because hypertension is almost without symptoms except for headaches in some patients, it hides in the body without knowing it.
•The fact that hypertension is asymptomatic makes it difficult for patients to accept the diagnosis and comply with treatment.
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In India more than over 140 million people are believed to be suffering from high blood pressure in the country and the number is expected to cross the 214 million mark in 2030.
Hypertension is a major risk factor for cardio-vascular diseases.
INTRODUCTION
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OBJECTIVESAt the end of this presentation you
should understand Define,classify and diagnosis of
hypertension Types of HT Identify risk factors &complications Treatment guidelines Complications and prevention
methods
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DEFINITIONHypertension is defined as a systolic
blood pressure (SBP) of 140 mm Hg or more, or a diastolic blood pressure (DBP) of 90 mm Hg.
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Blood pressure is the force applied against the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries.
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PATHOPHYSIOLOGY
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CAUSES &RISK FACTORS
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TYPESPrimary Hypertension-unknown
etiologySecondary Hypertension-due to
some other medical conditionHypertension in pregnancyMalignant Hypertension with end
organ damageParaoxysmal Hypertension
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SIGNS AND SYMPTOMSSevere headacheNausea or vomitingBad headache Confusion Changes in your visionNosebleeds
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Investigations Blood pressure evaluationFasting Blood Sugar (FBS) – To
diagnose diabetes Lipid Profile – To diagnose
dyslipidaemia Renal Profile- Serum Urea,
Albumin, Creatinine
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Measurement of BPThe patient must be properly
prepared and positionedCaffeine,exercise and smoking
should be avoided for atleast 30 minutes before.
Average of atleast three readings on three different occassions should be recorded.
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MANAGEMENT
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MANAGEMENTLIFE STYLE MODIFICATIONRegular physical activitySmoking cessationSalt restrictionAlcohol cessationWeight loss
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MANAGEMENTDIETARY PLANDASH-Dietary Approach to Stop
Hypertension
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MEDICATIONS
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A-B-C-D Blood Pressure Medications:
A: ACE inhibitors (angiotensin converting enzyme)prevent the formation of the hormone angiotensin 2 which causes blood vessels to become narrow making the vessels relax, becoming wider, lowering your blood pressure.
B: Beta Blockers reduce nerve impulses to the heart and blood vessels making the heart beat slower with less force to drop your blood pressure and the heart doesn't work a hard.
C: Calcium channel blockers block calcium from entering the muscle cells of the heart and blood vessels making them relax and lowering your blood pressure.
D: Diuretics, or water pills, work in the kidney by flushing out excess water and sodium from the body.
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Beta BlockerATENOLOLDecreases myocardial contractilityFall in cardiac outputDecreases blood pressureAdditionally it reduces renin secretion
Dosage-Atenolol 25-100mg once daily
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ADVERSE EFFECTS-BradycardiaCongestive heart diseaseAggravates asthmaSleep alteration
CONTRAINDIATIONS:-AsthmaDiabetes mellitusHeart blockHyperlipidemia
Beta Blocker
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ACE INHIBITORSEnalaprilActs by inbiting the conversion of
angiotensin 1 to angiotensin 2 thus preventing the vasoconstriction
Used in diabetics.DosageInitial dose (oral): 5 mg orally once a day.Maintenance dose (oral): 10 to 40 mg
orally per day in 1 to 2 divided doses.
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Side effects-First dose hypotensionDry coughUrticariaContraindiationRenal failurePregnancy
ACE INHIBITORS
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CALCIUM CHANNEL BLOCKERAmlodipineActs by relaxing the smooth muscle in
the arterial wall, decreasing total peripheral resistance thereby reducing blood pressure; in angina, amlodipine increases blood flow to the heart muscle.
Initial dose: 2.5 -5 mg orally once a dayMaintenance dose: 5 to 10 mg orally once a day
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Side effects-HeadacheEdemaFatigueNauseaDizzinessMuscle crampsContraindications-PregnancyBreast feeding
CALCIUM CHANNEL BLOCKER
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TREATMENT IN DIABETICS
Blood Pressure No diabetes Diabetes No diabetes Diabetes
Optimal <140/85 <140/80 <130/80 <130/75
Audit Standard <150/90 <140/85 <140/85 <140/80
Measured in clinic Mean daytime ABPM or home measurement
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FOLLOW UPUrine analysis-albumin,sugarComplete blood countLipid profileGlucose levelsOphthalmic examinationECG
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THANK YOU